AccountId: 011433970860
ContactId: c4dc04cd-3453-4ad0-9ce9-3cd1ac44fca0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 682159 ms
Total Talk Time (AGENT): 235732 ms
Total Talk Time (CUSTOMER): 191133 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/c4dc04cd-3453-4ad0-9ce9-3cd1ac44fca0_20250305T16:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] calling from the provider's office uh hello.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] I'm sorry, can you speak up please?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I can hear you better now. But could you repeat whatever you said?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] calling from the provider's office.
[AGENT][POSITIVE] Yes [PII], how can I help you today?
[CUSTOMER][NEUTRAL] Yeah, so the claim is denied for.
[CUSTOMER][NEUTRAL] 16 lakh for lack lack of information needed for adjudication. So with the VMA code in invalid PIN number.
[CUSTOMER][NEUTRAL] So I need clarification on that.
[AGENT][NEUTRAL] OK, you're needing clarification on a denial of a claim, is that correct?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, sir, I can help you with that and what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII], no extension.
[AGENT][NEUTRAL] OK, repeat that again, please.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEGATIVE] No extension.
[AGENT][NEUTRAL] Thank you. All right, thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Uh, the policy number is 025457.
[CUSTOMER][NEUTRAL] 74.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] And any information that I do provide for you [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the last name is [PII] and the first name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And what is the date of service and total bill amount please?
[CUSTOMER][NEUTRAL] Uh, it's from [PII], and total charge is $483 even.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, thank you and the claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, claim number is 025457774.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm sorry, what is?
[AGENT][NEUTRAL] OK, no, no, no, that was the policy number. Do you have the claim number that you that you were calling in regards to?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yeah, that's, that's the clear number I said but what are the.
[CUSTOMER][NEUTRAL] Same the policy number and the claim number.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that is incorrect.
[CUSTOMER][NEUTRAL] 5%
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] So just one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so now I do not have a claim on file for the billed amount that you're providing for me.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] Yes, the claim is not on file.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so what's the
[CUSTOMER][NEUTRAL] What's your name first?
[AGENT][NEUTRAL] OK, let me give me just a moment to look at something, please.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And you said again that the total bill amount on this claim was $483 is that correct?
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] date of services from [PII], yeah.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Mhm. OK, one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm waiting on
[AGENT][NEUTRAL] Um, the system's load some information for me. Just a moment please, [PII].
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] There's a call reference with them Katikavi.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so today that after looking at some additional information, the claim was received for this number. The claim number is going to be 3561276.
[AGENT][NEUTRAL] This claim was received on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] This claim, yes, it was denied.
[AGENT][NEUTRAL] The reason for the denial states we are unable to assign benefits to the provider of record due to a discrepancy with the provider's tax ID number.
[CUSTOMER][NEUTRAL] Uh, OK, can you please check your voices? Wait a second. Your voice was breaking.
[AGENT][NEUTRAL] A letter has been mailed to the provider. Do you have that in.
[CUSTOMER][NEUTRAL] Can you repeat that?
[CUSTOMER][NEUTRAL] So you have denied for?
[AGENT][NEGATIVE] We are unable to assign benefits to the provider of record due to a discrepancy with the provider's tax ID number.
[AGENT][NEUTRAL] A letter has been mailed to the provider with instructions on resolving the discrepancy.
[AGENT][NEUTRAL] The provider will need to resolve the discrepancy with our office to resume receiving communications regarding claim decisions and benefit payments.
[AGENT][NEUTRAL] Our claim decision.
[CUSTOMER][NEUTRAL] OK. When was it?
[AGENT][NEUTRAL] Do you want me to finish reading it?
[CUSTOMER][NEUTRAL] Uh, yes, go ahead.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Our claim decision, including any be payable benefits for this charge has been sent to the insured. Please contact our office with any questions.
[AGENT][NEUTRAL] And that was the same date as the process date that I gave you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] OK, let me check from our site to provide this.
[CUSTOMER][NEUTRAL] So the tax ID is incorrect, right?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits stated, you may print out by going to our portal which is located at [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] For your
[CUSTOMER][NEUTRAL] Better, so the provider is not uh enrolled with the tax ID, right?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] What I can do is I can take down the information I can send an email and have someone to return your call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, the denial reason you stated that the providers enroll, uh, not enrolled and not fine with the tax ID, right.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, so that is what I read to you. Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. First, I need your name. What's your name?
[AGENT][NEUTRAL] You need for me to give you that again?
[CUSTOMER][NEUTRAL] Uh, no, yes.
[AGENT][NEUTRAL] No, or, yes, you do need it.
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] We have built the correct tax ID for this account.
[AGENT][NEUTRAL] Again, for further information regarding this notice, I would need to have someone to return your call.
[CUSTOMER][NEUTRAL] I can.
[CUSTOMER][NEUTRAL] OK. So, can you clarify that when was the letter was sent?
[AGENT][NEUTRAL] Again, it was sent the same day as I gave you as the process date, would have been mailed out the next day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the call reference?
[AGENT][NEUTRAL] My name and today's dat[PII]
[CUSTOMER][POSITIVE] OK, [PII], thank you for the information. Have a great day. Bye for now.
[AGENT][POSITIVE] Oh, you're very welcome. Yes, sir. If that is all I can help you with, [PII]. Thank you again for calling APL and I hope you have a nice day as well.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Uh-huh, bye-bye.
[CUSTOMER][NEUTRAL] Yeah